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Saad M, Tonetti J, Kerschbaumer G, Boudissa M. Navigated pedicle screw insertion with the Surgivisio system: Malposition rate and risk factors - about 648 screws. Orthop Traumatol Surg Res 2024:103899. [PMID: 38677474 DOI: 10.1016/j.otsr.2024.103899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 02/06/2024] [Accepted: 04/23/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE Pedicle screw malposition rates vary greatly in scientific literature depending on the chosen criteria. Different techniques have been developed to lower the risk of screw malposition. Our primary objective is to evaluate the malposition rate associated with the use of the Surgivisio navigation system and to identify risk factors for screw malposition. The secondary objectives are to assess operating time and radiation data. MATERIALS AND METHODS We performed a monocentric retrospective consecutive case series. All patients operated for pedicle screw implantation using the Surgivisio system between September 2017 and June 2020 were included. Screw positioning was evaluated on postoperative CT scans using Heary and Gertzbein classifications. Thirteen potential risk factors for screw malposition were hypothesized and tested with a univariate and multivariate analysis. RESULTS Six hundred and forty-eight screws could be evaluated in 97 patients. Our study reported a 92.4% satisfactory screw implantation rate with a mean operative time per screw of 14.5±6.7minutes and a patient effective dose of 0.47±0.31 mSv per screw. One screw was neurotoxic and required an early revision (0.15%). Three risk factors for screw malposition have been identified in a multivariate analysis: female gender (OR=2.13 [1.11; 4], p=0.0219), an implantation level above D10 (OR=2.17 [1.13; 4.16], p=0.0197), and an "open" surgery (as opposed to percutaneous) (OR=3.47 [1.83; 6.56], p=0.0002). CONCLUSION Pedicle screw malposition rate and operative time with the Surgivisio navigation system are comparable with those reported in scientific literature. We theorized that intraoperative patient reference displacement could be a major cause of navigation failure. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Maxime Saad
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; Université Grenoble-Alpes, Grenoble, France.
| | - Jérôme Tonetti
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; Université Grenoble-Alpes, Grenoble, France; CNRS UMR 5525, laboratoire TIMC-IMAG, université Grenoble-Alpes, pavillon Taillefer, 38700 La Tronche, France
| | - Gaël Kerschbaumer
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; Université Grenoble-Alpes, Grenoble, France
| | - Mehdi Boudissa
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; Université Grenoble-Alpes, Grenoble, France; CNRS UMR 5525, laboratoire TIMC-IMAG, université Grenoble-Alpes, pavillon Taillefer, 38700 La Tronche, France
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Vadalà G, Papalia GF, Russo F, Brigato P, Ambrosio L, Papalia R, Denaro V. Intraoperative Cone-Beam Computed Tomography Navigation Versus 2-Dimensional Fluoroscopy in Single-Level Lumbar Spinal Fusion: A Comparative Analysis. Neurospine 2024; 21:76-82. [PMID: 38569632 PMCID: PMC10992660 DOI: 10.14245/ns.2347106.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE Several studies have advocated for the higher accuracy of transpedicular screw placement under cone-beam computed tomography (CBCT) compared to conventional 2-dimensional (2D) fluoroscopy. The superiority of navigation systems in perioperative and postoperative outcomes remains a topic of debate. This study aimed to compare operative time, screw placement time and accuracy, total radiation dose, perioperative and postoperative outcomes in patients who underwent transpedicular screw fixation for degenerative lumbar spondylolisthesis (DLS) using intraoperative CBCT navigation versus 2D fluoroscopy. METHODS A retrospective analysis was conducted on patients affected by single-level DLS who underwent posterior lumbar instrumentation with transpedicular screw fixation using surgical CBCT navigation (NV group) or 2D fluoroscopy-assisted freehand technique (FH group). Demographics, screw placement time and accuracy, operative time, total radiation dose, intraoperative blood loss, screw revision rate, complications, and length of stay (LOS) were assessed. RESULTS The study included a total of 30 patients (NV group: n = 15; FH group: n = 15). The mean screw placement time, operative time, and LOS were significantly reduced in the NV group compared to the FH group (p < 0.05). The total radiation dose was significantly higher in the NV group (p < 0.0001). No significant difference was found in terms of blood loss and postoperative complications. CONCLUSION This study suggests that intraoperative CBCT-navigated single-level lumbar transpedicular screw fixation is superior in terms of mean screw placement time, operative time, and LOS compared to 2D fluoroscopy, despite a higher intraoperative radiation exposure.
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Affiliation(s)
- Gianluca Vadalà
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy
| | - Giuseppe Francesco Papalia
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy
| | - Fabrizio Russo
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy
| | - Paolo Brigato
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy
| | - Luca Ambrosio
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy
| | - Rocco Papalia
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy
| | - Vincenzo Denaro
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
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Li YD, Lai PL, Hsieh MK, Chen WP, Lee DM, Tsai TT, Tai CL. Influence of various pilot hole profiles on pedicle screw fixation strength in minimally invasive and traditional spinal surgery: a comparative biomechanical study. Front Bioeng Biotechnol 2024; 12:1359883. [PMID: 38380264 PMCID: PMC10877418 DOI: 10.3389/fbioe.2024.1359883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/25/2024] [Indexed: 02/22/2024] Open
Abstract
Despite advancements in pedicle screw design and surgical techniques, the standard steps for inserting pedicle screws still need to follow a set of fixed procedures. The first step, known as establishing a pilot hole, also referred to as a pre-drilled hole, is crucial for ensuring screw insertion accuracy. In different surgical approaches, such as minimally invasive or traditional surgery, the method of creating pilot holes varies, resulting in different pilot hole profiles, including variations in size and shape. The aim of this study is to evaluate the biomechanical properties of different pilot hole profiles corresponding to various surgical approaches. Commercially available synthetic L4 vertebrae with a density of 0.16 g/cc were utilized as substitutes for human bone. Four different pilot hole profiles were created using a 3.0 mm cylindrical bone biopsy needle, 3.6 mm cylindrical drill, 3.2-5.0 mm conical drill, and 3.2-5.0 mm conical curette for simulating various minimally invasive and traditional spinal surgeries. Two frequently employed screw shapes, namely, cylindrical and conical, were selected. Following specimen preparation, screw pullout tests were performed using a material test machine, and statistical analysis was applied to compare the mean maximal pullout strength of each configuration. Conical and cylindrical screws in these four pilot hole configurations showed similar trends, with the mean maximal pullout strength ranking from high to low as follows: 3.0 mm cylindrical biopsy needle, 3.6 mm cylindrical drill bit, 3.2-5.0 mm conical curette, and 3.2-5.0 mm conical drill bit. Conical screws generally exhibited a greater mean maximal pullout strength than cylindrical screws in three of the four different pilot hole configurations. In the groups with conical pilot holes, created with a 3.2-5.0 mm drill bit and 3.2-5.0 mm curette, both conical screws exhibited a greater mean maximal pullout strength than did cylindrical screws. The strength of this study lies in its comprehensive comparison of the impact of various pilot hole profiles commonly used in clinical procedures on screw fixation stability, a topic rarely reported in the literature. Our results demonstrated that pilot holes created for minimally invasive surgery using image-guided techniques exhibit superior pullout strength compared to those utilized in traditional surgery. Therefore, we recommend prioritizing minimally invasive surgery when screw implantation is anticipated to be difficult or there is a specific need for stronger screw fixation. When opting for traditional surgery, image-guided methods may help establish smaller pilot holes and increase screw fixation strength.
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Affiliation(s)
- Yun-Da Li
- Department of Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Orthopedic Surgery, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan
| | - Po-Liang Lai
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Kai Hsieh
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Weng-Pin Chen
- Department of Mechanical Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - De-Mei Lee
- Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Ting Tsai
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ching-Lung Tai
- Department of Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
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Ghenbot Y, Ahmad HS, Chauhan D, Wathen C, Arena J, Turlip R, Parr R, Gibby W, Yoon JW. Effects of Augmented Reality on Thoracolumbar Pedicle Screw Instrumentation Across Different Levels of Surgical Experience. World Neurosurg 2024; 182:e284-e291. [PMID: 38008167 DOI: 10.1016/j.wneu.2023.11.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE Augmented reality (AR) is an emerging technology that may accelerate skill acquisition and improve accuracy of thoracolumbar pedicle screw placements. We aimed to quantify the relative assistance of AR compared with freehand (FH) pedicle screw accuracy across different surgical experience levels. METHODS A spine fellowship-trained and board-certified attending neurosurgeon, postgraduate year 4 neurosurgery resident, and second-year medical student placed 32 FH and 32 AR-assisted thoracolumbar pedicle screws in 3 cadavers. A cableless, voice-activated AR system was paired with a headset. Accuracy was assessed using χ2 analysis and the Gertzbein-Robbins scale. Angular error, distance error, and time per pedicle screw were collected and compared. RESULTS The attending neurosurgeon had 91.6% (11/12) clinically acceptable (Gertzbein-Robbins scale A or B) insertion in both FH and AR groups; the resident neurosurgeon had 100% (9/9) FH and AR in both cases; the medical student had 72.3% (8/11) FH accuracy and 81.8% (9/11) AR accuracy. The medical student displayed significantly lower ideal (Gertzbein-Robbins scale A) FH accuracy compared with the resident neurosurgeon (P = 0.017) and attending neurosurgeon (P = 0.005), but no difference when using AR. FH screw placement was faster by both the attending neurosurgeon (median 46 seconds vs. 94.5 seconds, P = 0.0047) and the neurosurgery resident neurosurgeon (median 144 seconds vs. 140 seconds, P = 0.05). Total clinically acceptable AR and FH accuracy was 90.6% (29/32) and 87.5% (28/32), respectively (P = 0.69). CONCLUSIONS AR screw placement allowed an inexperienced medical student to double their accuracy in 1 training session. With subsequent iterations, this promising technology could serve as an important tool for surgical training.
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Affiliation(s)
- Yohannes Ghenbot
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Connor Wathen
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Arena
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan Turlip
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan Parr
- Novarad Corporation, Provo, Utah, USA
| | - Wendell Gibby
- Novarad Corporation, Provo, Utah, USA; Department of Radiology, University of California San Diego School of Medicine, San Diego, California, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Obid P, Zahnreich S, Frodl A, Rahim T, Niemeyer T, Mayr M. Freehand Technique for Pedicle Screw Placement during Surgery for Adolescent Idiopathic Scoliosis Is Associated with Less Ionizing Radiation Compared to Intraoperative Navigation. J Pers Med 2024; 14:142. [PMID: 38392576 PMCID: PMC10890154 DOI: 10.3390/jpm14020142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
PURPOSE We aim to compare radiation exposure and implant-related complications of the freehand (FH) technique versus intraoperative image-guided navigation (IN) for pedicle screw placement in adolescent idiopathic scoliosis (AIS) and estimate associated lifetime attributable cancer risks. METHODS A retrospective analysis of prospectively collected data from 40 consecutive AIS patients treated with pedicle screw instrumentation using the FH technique was performed. The dose area product (DAP) and effective dose (ED) were calculated. Screw-related complications were analysed, and the age- and gender-specific lifetime attributable cancer risks were estimated. The results were compared to previously published data on IN used during surgery for AIS. RESULTS There were no implant-related complications in our cohort. Implant density was 86.6%. The mean Cobb angle of the main curve was 75.2° (SD ± 17.7) preoperatively and 27.7° (SD ± 10.8) postoperatively. The mean ED of our cohort and published data for the FH technique was significantly lower compared to published data on the IN technique (p < 0.001). The risk for radiogenic cancer for our FH technique AIS cohort was 0.0014% for male patients and 0.0029% for female patients. Corresponding risks for IN were significantly higher (p < 0.001), ranging from 0.0071 to 0.124% and from 0.0144 to 0.253% for male and female patients, respectively. CONCLUSION The routine use of intraoperative navigation in AIS surgery does not necessarily reduce implant-related complications but may increase radiation exposure to the patient.
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Affiliation(s)
- Peter Obid
- Department of Orthopaedics and Traumatology, University Medical Center Freiburg, 79106 Freiburg, Germany
| | - Sebastian Zahnreich
- Department of Radiation Oncology and Radiation Therapy, Mainz University Hospital, 55131 Mainz, Germany
| | - Andreas Frodl
- Department of Orthopaedics and Traumatology, University Medical Center Freiburg, 79106 Freiburg, Germany
| | - Tamim Rahim
- Spine and Scoliosis Center, Asklepios Klinik Wiesbaden, 65197 Wiesbaden, Germany
| | - Thomas Niemeyer
- Spine and Scoliosis Center, Asklepios Klinik Wiesbaden, 65197 Wiesbaden, Germany
| | - Moritz Mayr
- Department of Orthopaedics and Traumatology, University Medical Center Freiburg, 79106 Freiburg, Germany
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Hadgaonkar S, Gupta A, Aiyer S, Bhilare P, Sancheti P. Learning curve across 2000 thoracolumbar pedicle screw placements using O-arm navigation: technical difficulties and their solutions. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3753-3763. [PMID: 37698694 DOI: 10.1007/s00586-023-07922-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/22/2023] [Accepted: 08/26/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION Instrumentation using the intraoperative O-arm navigation technique appears safer than its predecessor techniques. However, only a handful of surgeons often used navigation during spinal surgeries. Too many operative glitches and unreliable navigation accuracy were the important reasons cited even by experienced surgeons for not using spinal navigation. We have studied the accuracy of pedicle screw placement during the learning curve and beyond it. We have also discussed in detail the intricacies of the technique and solutions to the difficulties encountered using spinal navigation. MATERIALS AND METHODS A total of 2000 thoracolumbar pedicle screws have been placed in the 324 spine surgeries meeting the inclusion and exclusion criteria included in this retrospective study. We have divided 2000 pedicle screw placements into consecutive groups of 200 each. We have compared these groups for the accuracy of screw placement with the surgeon's experience. RESULTS The accuracy of pedicle screw placement using the "in-versus-out" grading system in group 1 was 85.5% which significantly increased in group 2 to 93.5% (p-value: 0.0099), and thereafter, there was a nonsignificant increase in subsequent groups with the graph achieving the shape of a plateau. CONCLUSION Surgeons should learn the correct principles of the technique of O-arm navigation to prevent the loss of accuracy and place pedicle screws with high accuracy. There is a learning curve of around 30-35 surgeries or 200 pedicle screw placements to acclimatize with the technique of O-arm navigation and learn its principles.
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Affiliation(s)
- Shailesh Hadgaonkar
- Department of Spine Surgery, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
| | - Alok Gupta
- Department of Spine Surgery, Indraprastha Apollo Hospital, New Delhi, India.
| | - Siddharth Aiyer
- Department of Spine Surgery, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
| | - Pramod Bhilare
- Department of Spine Surgery, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
| | - Parag Sancheti
- Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
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Constant C, Aubin CE, Kremers HM, Garcia DVV, Wyles CC, Rouzrokh P, Larson AN. The use of deep learning in medical imaging to improve spine care: A scoping review of current literature and clinical applications. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 15:100236. [PMID: 37599816 PMCID: PMC10432249 DOI: 10.1016/j.xnsj.2023.100236] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 06/14/2023] [Indexed: 08/22/2023]
Abstract
Background Artificial intelligence is a revolutionary technology that promises to assist clinicians in improving patient care. In radiology, deep learning (DL) is widely used in clinical decision aids due to its ability to analyze complex patterns and images. It allows for rapid, enhanced data, and imaging analysis, from diagnosis to outcome prediction. The purpose of this study was to evaluate the current literature and clinical utilization of DL in spine imaging. Methods This study is a scoping review and utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to review the scientific literature from 2012 to 2021. A search in PubMed, Web of Science, Embased, and IEEE Xplore databases with syntax specific for DL and medical imaging in spine care applications was conducted to collect all original publications on the subject. Specific data was extracted from the available literature, including algorithm application, algorithms tested, database type and size, algorithm training method, and outcome of interest. Results A total of 365 studies (total sample of 232,394 patients) were included and grouped into 4 general applications: diagnostic tools, clinical decision support tools, automated clinical/instrumentation assessment, and clinical outcome prediction. Notable disparities exist in the selected algorithms and the training across multiple disparate databases. The most frequently used algorithms were U-Net and ResNet. A DL model was developed and validated in 92% of included studies, while a pre-existing DL model was investigated in 8%. Of all developed models, only 15% of them have been externally validated. Conclusions Based on this scoping review, DL in spine imaging is used in a broad range of clinical applications, particularly for diagnosing spinal conditions. There is a wide variety of DL algorithms, database characteristics, and training methods. Future studies should focus on external validation of existing models before bringing them into clinical use.
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Affiliation(s)
- Caroline Constant
- Orthopedic Surgery AI Laboratory, Mayo Clinic, 200 1st St Southwest, Rochester, MN, 55902, United States
- Polytechnique Montreal, 2500 Chem. de Polytechnique, Montréal, QC H3T 1J4, Canada
- AO Research Institute Davos, Clavadelerstrasse 8, CH 7270, Davos, Switzerland
| | - Carl-Eric Aubin
- Polytechnique Montreal, 2500 Chem. de Polytechnique, Montréal, QC H3T 1J4, Canada
| | - Hilal Maradit Kremers
- Orthopedic Surgery AI Laboratory, Mayo Clinic, 200 1st St Southwest, Rochester, MN, 55902, United States
| | - Diana V. Vera Garcia
- Orthopedic Surgery AI Laboratory, Mayo Clinic, 200 1st St Southwest, Rochester, MN, 55902, United States
| | - Cody C. Wyles
- Orthopedic Surgery AI Laboratory, Mayo Clinic, 200 1st St Southwest, Rochester, MN, 55902, United States
- Department of Orthopedic Surgery, Mayo Clinic, 200, 1st St Southwest, Rochester, MN, 55902, United States
| | - Pouria Rouzrokh
- Orthopedic Surgery AI Laboratory, Mayo Clinic, 200 1st St Southwest, Rochester, MN, 55902, United States
- Radiology Informatics Laboratory, Mayo Clinic, 200, 1st St Southwest, Rochester, MN, 55902, United States
| | - Annalise Noelle Larson
- Orthopedic Surgery AI Laboratory, Mayo Clinic, 200 1st St Southwest, Rochester, MN, 55902, United States
- Department of Orthopedic Surgery, Mayo Clinic, 200, 1st St Southwest, Rochester, MN, 55902, United States
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Bonello JP, Koucheki R, Abbas A, Lex J, Nucci N, Yee A, Ahn H, Finkelstein J, Lewis S, Larouche J, Toor J. Comparison of major spine navigation platforms based on key performance metrics: a meta-analysis of 16,040 screws. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2937-2948. [PMID: 37474627 DOI: 10.1007/s00586-023-07865-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/28/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE The objective of this meta-analysis is to compare available computer-assisted navigation platforms by key performance metrics including pedicle screw placement accuracy, operative time, neurological complications, and blood loss. METHODS A systematic review was conducted using major databases for articles comparing pedicle screw accuracy of computer-assisted navigation to conventional (freehand or fluoroscopy) controls via post-operative computed tomography. Outcome data were extracted and pooled by random-effects model for analysis. RESULTS All navigation platforms demonstrated significant reduction in risk of breach, with Stryker demonstrating the highest accuracy compared to controls (OR 0.16 95% CI 0.06 to 0.41, P < 0.00001, I2 = 0%) followed by Medtronic. There were no significant differences in accuracy or most surgical outcome measures between platforms; however, BrainLab demonstrated significantly faster operative time compared to Medtronic by 30 min (95% CI - 63.27 to - 2.47, P = 0.03, I2 = 74%). Together, there was significantly lower risk of major breach in the navigation group compared to controls (OR 0.42, 95% CI 0.27-0.63, P < 0.0001, I2 = 56%). CONCLUSIONS When comparing between platforms, Stryker demonstrated the highest accuracy, and Brainlab the shortest operative time, both followed by Medtronic. No significant difference was found between platforms regarding neurologic complications or blood loss. Overall, our results demonstrated a 60% reduction in risk of major breach utilizing computer-assisted navigation, coinciding with previous studies, and supporting its validity. This study is the first to directly compare available navigation platforms offering insight for further investigation and aiding in the institutional procurement of platforms. LEVEL 3 EVIDENCE: Meta-analysis of Level 3 studies.
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Affiliation(s)
- John-Peter Bonello
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
| | - Robert Koucheki
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Aazad Abbas
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Johnathan Lex
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
| | - Nicholas Nucci
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Canada
| | - Albert Yee
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
- Department of Orthopaedic Surgery, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Henry Ahn
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
- Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Canada
| | - Joel Finkelstein
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
- Department of Orthopaedic Surgery, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Stephen Lewis
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
- Department of Orthopaedic Surgery, Toronto Western Hospital, Toronto, Canada
| | - Jeremie Larouche
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
- Department of Orthopaedic Surgery, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Jay Toor
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
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Cao B, Yuan B, Xu G, Zhao Y, Sun Y, Wang Z, Zhou S, Xu Z, Wang Y, Chen X. A Pilot Human Cadaveric Study on Accuracy of the Augmented Reality Surgical Navigation System for Thoracolumbar Pedicle Screw Insertion Using a New Intraoperative Rapid Registration Method. J Digit Imaging 2023; 36:1919-1929. [PMID: 37131064 PMCID: PMC10406793 DOI: 10.1007/s10278-023-00840-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/04/2023] Open
Abstract
To evaluate the feasibility and accuracy of AR-assisted pedicle screw placement using a new intraoperative rapid registration method of combining preoperative CT scanning and intraoperative C-arm 2D fluoroscopy in cadavers. Five cadavers with intact thoracolumbar spines were employed in this study. Intraoperative registration was performed using anteroposterior and lateral views of preoperative CT scanning and intraoperative 2D fluoroscopic images. Patient-specific targeting guides were used for pedicle screw placement from Th1-L5, totaling 166 screws. Instrumentation for each side was randomized (augmented reality surgical navigation (ARSN) vs. C-arm) with an equal distribution of 83 screws in each group. CT was performed to evaluate the accuracy of both techniques by assessing the screw positions and the deviations between the inserted screws and planned trajectories. Postoperative CT showed that 98.80% (82/83) screws in ARSN group and 72.29% (60/83) screws in C-arm group were within the 2-mm safe zone (p < 0.001). The mean time for instrumentation per level in ARSN group was significantly shorter than that in C-arm group (56.17 ± 3.33 s vs. 99.22 ± 9.03 s, p < 0.001). The overall intraoperative registration time was 17.2 ± 3.5 s per segment. AR-based navigation technology can provide surgeons with accurate guidance of pedicle screw insertion and save the operation time by using the intraoperative rapid registration method of combining preoperative CT scanning and intraoperative C-arm 2D fluoroscopy.
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Affiliation(s)
- Bing Cao
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, China
| | - Bo Yuan
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, China
| | - Guofeng Xu
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, China
| | - Yin Zhao
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, China
| | - Yanqing Sun
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, China
| | - Zhiwei Wang
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, China
| | - Shengyuan Zhou
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, China
| | - Zheng Xu
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, China
| | - Yao Wang
- Linyan Medical Technology Company Limited, 528 Ruiqing Road, Pudong New District, Shanghai, China
| | - Xiongsheng Chen
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, China.
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Mandelka E, Gierse J, Zimmermann F, Gruetzner PA, Franke J, Vetter SY. Implications of navigation in thoracolumbar pedicle screw placement on screw accuracy and screw diameter/pedicle width ratio. BRAIN & SPINE 2023; 3:101780. [PMID: 38020982 PMCID: PMC10668071 DOI: 10.1016/j.bas.2023.101780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/22/2023] [Accepted: 07/10/2023] [Indexed: 12/01/2023]
Abstract
Introduction There is ample evidence that higher accuracy can be achieved in thoracolumbar pedicle screw placement by using spinal navigation. Still, to date, the evidence regarding the influence of the use of navigation on the screw diameter to pedicle width ratio remains limited. Research question The aim of this study was to investigate the implications of navigation in thoracolumbar pedicle screw placement not only on screw accuracy, but on the screw diameter to pedicle width ratio as well. Material and methods In this single-center single-surgeon study, 45 Patients undergoing navigated thoracolumbar pedicle screw placement were prospectively included. The results were compared with a matched comparison group of patients in which screw placement was performed under fluoroscopic guidance. The screw accuracy and the screw diameter to pedicle width ratio of every screw were compared between the groups. Results Screw accuracy was significantly higher in the navigation group compared to the fluoroscopic guidance group, alongside with a significant increase of the screw diameter to pedicle width ratio by approximately 10%. In addition, both the intraoperative radiation dose and the operating time tended to be lower in the study group. Conclusion This study was able to show that navigated thoracolumbar pedicle screw placement not only increases the accuracy of screw placement but also facilitates the selection of the adequate screw sizes, which according to the literature has positive effects on fixation strength. Meanwhile, the use of navigation did not negatively affect the time needed for surgery or the patient's intraoperative exposure to radiation.
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Affiliation(s)
- Eric Mandelka
- Research group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Department of Orthopedics and Trauma Surgery, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Jula Gierse
- Research group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Department of Orthopedics and Trauma Surgery, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Felix Zimmermann
- Research group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Department of Orthopedics and Trauma Surgery, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Paul A. Gruetzner
- Research group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Department of Orthopedics and Trauma Surgery, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Jochen Franke
- Research group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Department of Orthopedics and Trauma Surgery, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Sven Y. Vetter
- Research group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Department of Orthopedics and Trauma Surgery, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
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11
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Romagna A, Sperker S, Lumenta C, Tomasino A, Schwartz C, Lehmberg J, Zausinger S, Schul D. Robot-assisted versus navigated transpedicular spine fusion: A comparative study. Int J Med Robot 2023; 19:e2500. [PMID: 36649651 DOI: 10.1002/rcs.2500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/29/2022] [Accepted: 01/12/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND The aim of this study was to compare the intraoperative and postoperative outcomes between a robot-assisted versus a navigated transpedicular fusion technique. METHODS This retrospective analysis included patients who underwent transpedicular posterior fusion of the spine due to trauma, pyogenic spondylodiscitis and osteoporosis. Surgery was done either with a robot-assisted or a percutaneous navigated transpedicular fusion technique. The outcome analysis included the duration of surgery, the radiation exposure, the postoperative screw position and complications. RESULTS A total of 60 patients were operated and 491 screws were analysed. No statistical difference was seen in the applied cumulative effective radiation dose per patient. The radiological assessment revealed a more accurate screw placement with robot assistance. A learning curve could be observed in robot-assisted fusion. CONCLUSION Robot-assisted and navigated transpedicular fusion techniques are both effective and safe. Robot-assisted transpedicular spine fusion goes along with higher placement accuracy but its implementation needs an adequate learning curve.
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Affiliation(s)
- Alexander Romagna
- Department of Neurosurgery, München Klinik Bogenhausen, Munich, Germany.,Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Sarah Sperker
- Department of Neurosurgery, München Klinik Bogenhausen, Munich, Germany
| | | | - Andre Tomasino
- Department of Neurosurgery, Inn Klinikum Altötting und Mühldorf, Mühldorf, Germany
| | - Christoph Schwartz
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Jens Lehmberg
- Department of Neurosurgery, München Klinik Bogenhausen, Munich, Germany
| | | | - David Schul
- Department of Neurosurgery, München Klinik Bogenhausen, Munich, Germany
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12
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Märdian S, Maleitzke T, Niemann M, Salmoukas K, Stöckle U. [Imaging examination procedures, navigation and minimally invasive procedures in acetabular surgery]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:89-99. [PMID: 36645450 DOI: 10.1007/s00113-022-01281-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/17/2023]
Abstract
Acetabular fractures still pose a special challenge even today. Considering the increasing case numbers, especially in the geriatric patient group, modern imaging examination procedures represent an essential pillar of the diagnostics. Especially in this vulnerable patient group, minimally invasive methods are necessary, which can be guaranteed by intraoperative navigation; however, the choice of surgical access and implants is also made based on the existing morphological characteristics of fractures, which highlights the importance of an imaging modality that is as detailed as possible. Last but not least, new developments concerning the surgical treatment of these injuries are also based on this. This article summarizes the current state of the techniques and the available literature.
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Affiliation(s)
- Sven Märdian
- Centrum für Muskuloskeletale Chirurgie, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - T Maleitzke
- Centrum für Muskuloskeletale Chirurgie, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.,Julius Wolff Institut, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.,BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - M Niemann
- Centrum für Muskuloskeletale Chirurgie, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.,Julius Wolff Institut, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - K Salmoukas
- Centrum für Muskuloskeletale Chirurgie, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - U Stöckle
- Centrum für Muskuloskeletale Chirurgie, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
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13
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Lopez IB, Benzakour A, Mavrogenis A, Benzakour T, Ahmad A, Lemée JM. Robotics in spine surgery: systematic review of literature. INTERNATIONAL ORTHOPAEDICS 2023; 47:447-456. [PMID: 35849162 DOI: 10.1007/s00264-022-05508-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Over 4.83 million spine surgery procedures are performed annually around the world. With the considerable caseload and the precision needed to achieve optimal spinal instrumentation, technical progress has helped to improve the technique's safety and accuracy with the development of peri-operative assistance tools. Contrary to other surgical applications already part of the standard of care, the development of robotics in spine surgery is still a novelty and is not widely available nor used. Robotics, especially when coupled with other guidance modalities such as navigation, seems to be a promising tool in our quest for accuracy, improving patient outcomes and reducing surgical complications. Robotics in spine surgery may also be for the surgeon a way to progress in terms of ergonomics, but also to respond to a growing concern among surgical teams to reduce radiation exposure. METHOD We present in this recent systematic review of the literature realized according to the PRISMA guidelines the place of robotics in spine surgery, reviewing the comparison to standard techniques, the current and future indications, the learning curve, the impact on radiation exposure, and the cost-effectiveness. RESULTS Seventy-six relevant original studies were identified and analyzed for the review. CONCLUSION Robotics has proved to be a safe help for spine surgery, both for the patient with a decrease of operating time and increase in pedicular screw accuracy, and for the surgical team with a decrease of radiation exposure. Medico-economic studies demonstrated that despite a high buying cost, the purchase of a robot dedicated for spine surgery is cost-effective resulting in lesser revision, lower infection, reduced length of stay, and shorter surgical procedure.
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Affiliation(s)
- Ignacio Barrio Lopez
- Department of Neurosurgery, University Hospital of Angers, 4, rue Larrey, 49933, Angers Cedex 09, France
| | - Ahmed Benzakour
- Centre Orléanais du Dos, Pôle Santé Oréliance, Saran, France
| | - Andreas Mavrogenis
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Jean-Michel Lemée
- Department of Neurosurgery, University Hospital of Angers, 4, rue Larrey, 49933, Angers Cedex 09, France. .,INSERM CRCI2NA Team 5, GLIAD, Angers, France.
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14
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Single-Position Oblique Lumbar Interbody Fusion and Percutaneous Pedicle Screw Fixation under O-Arm Navigation: A Retrospective Comparative Study. J Clin Med 2022; 12:jcm12010312. [PMID: 36615112 PMCID: PMC9821558 DOI: 10.3390/jcm12010312] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
The insertion of pedicle screws in the lateral position without a position change has been reported. We completed a retrospective comparison of the radiologic and clinical outcomes of 36 patients who underwent either single-position oblique lateral lumbar interbody fusion (SP-OLIF) using the O-arm (36 cases) or conventional OLIF (C-OLIF) using the C-arm (20 cases) for L2-5 single-level lumbar degenerative diseases. Radiological parameters were analyzed, including screw accuracy (Gertzbein-Robbins classification system; GRS), segmental instability, and fusion status. Screw misplacement was defined as a discrepancy of ≥2 mm. Clinical outcomes, including visual analog scale, Oswestry Disability Index (ODI), 36-Item Short Form Health Survey (SF-36), and postoperative complications, were assessed. The spinal fusion rate was not different between the SP-OLIF and C-OLIF groups one year after surgery (p = 0.536). The ODI score was lower (p = 0.015) in the SP-OLIF than the C-OLIF group. Physical (p = 0.000) and mental component summaries (p = 0.000) of the SF-36 were significantly higher in the SP-OLIF group. Overall complication rates, including revision, surgical site infection, ipsilateral weakness, and radicular pain/numbness, were not significantly different. SP-OLIF using the O-arm procedure is feasible, with acceptable accuracy, fusion rate, and complication rate. This may be an alternative to conventional two-stage operations.
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15
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Sharma M, Uddin SA, Hanna G, Ugiliweneza B, Kim TT, Johnson JP, Boakye M, Drazin D. Trends and Long-term Health Care Utilization of Computer-assisted Neuronavigation in Spine Fusions: An Exact Matched Analysis of National Administrative Database. World Neurosurg 2022; 166:e850-e858. [PMID: 35944855 DOI: 10.1016/j.wneu.2022.07.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Computer-assisted neuronavigation (CAN) during spine fusions has increasingly been utilized in the United States. The aim of this study was to analyze the trends, health care utilization, and clinical outcomes associated with CAN use. METHODS The MarketScan database was queried using the ICD-9/10 and CPT 4th edition, from 2003 to 2019. We included patients aged ≥18 years with at least 2 years of follow-up. Outcomes were repeat/new fusions, length of stay (LOS), discharge disposition, hospital re-admissions, outpatient services, and medication refills for up to 24 months. RESULTS Of 183,620 patients who underwent spine fusions, 5046 (2.75%) were identified to have CAN utilized. CAN is increasingly being utilized for spine fusions since 2010, reaching 10.76% of all fusions in 2017, compared to 0.38% in 2010. CAN had no impact on LOS, home discharge, or complications at index hospitalization and 30-days post discharge. CAN was associated with lower rates of repeat fusions at 6 months (1% vs. 2%) and 24 months (5% vs. 6%), P < 0.05. Patients who underwent CAN had lower payments at 6 months ($5186 vs. $5527, P = 0.0159), 12 months ($10,267 v.s $11,262, P = 0.0207), and 24 months ($21,453 vs. $24,355, P = 0.0021). CONCLUSIONS CAN is increasing being used for spine fusions primarily for thoracolumbar procedures. No difference in complications, discharge disposition, and LOS were noted across the cohorts at index hospitalization, with higher index payments with CAN use. CAN was associated with lower rates of repeat fusions and corresponding health care utilization for up to 24 months.
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Affiliation(s)
- Mayur Sharma
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA.
| | - Syed Abdullah Uddin
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - George Hanna
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Beatrice Ugiliweneza
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA; Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA; Department of Health Management and Systems Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Terrence T Kim
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - J Patrick Johnson
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA; Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Doniel Drazin
- Department of Neurosurgery, Providence Regional Medical Center, Everett, Washington, USA
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16
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Mandelka E, Gierse J, Gruetzner PA, Franke J, Vetter SY. First Clinical Experience with a Novel 3D C-Arm-Based System for Navigated Percutaneous Thoracolumbar Pedicle Screw Placement. Medicina (B Aires) 2022; 58:medicina58081111. [PMID: 36013578 PMCID: PMC9414596 DOI: 10.3390/medicina58081111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: Navigated pedicle screw placement is becoming increasingly popular, as it has been shown to reduce the rate of screw misplacement. We present our intraoperative workflow and initial experience in terms of safety, efficiency, and clinical feasibility with a novel system for a 3D C-arm cone beam computed-tomography-based navigation of thoracolumbar pedicle screws. Materials and Methods: The first 20 consecutive cases of C-arm cone beam computed-tomography-based percutaneous pedicle screw placement using a novel navigation system were included in this study. Procedural data including screw placement time and patient radiation dose were prospectively collected. Final pedicle screw accuracy was assessed using the Gertzbein–Robbins grading system. Results: In total, 156 screws were placed. The screw accuracy was 94.9%. All the pedicle breaches occurred on the lateral pedicle wall, and none caused clinical complications. On average, a time of 2:42 min was required to place a screw. The mean intraoperative patient radiation exposure was 7.46 mSv. Conclusions: In summary, the investigated combination of C-arm CBCT-based navigation proved to be easy to implement and highly reliable. It facilitates the accurate and efficient percutaneous placement of pedicle screws in the thoracolumbar spine. The careful use of intraoperative imaging maintains the intraoperative radiation exposure to the patient at a moderate level.
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17
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Holste KG, Zaki MM, Wieland CM, Saadeh YS, Park P. The impact of misplaced percutaneous iliac dynamic reference frame pins used during navigated spine surgery: incidence and outcomes. J Neurosurg Spine 2022; 37:208-212. [PMID: 35276644 DOI: 10.3171/2022.1.spine211496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/13/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Image guidance requires placement of a dynamic reference frame (DRF), often either onto local spinous process or by freehand intraosseous DRF placement into the ilium via the posterior superior iliac spine (PSIS). There is a paucity of studies in the literature that describe the complications of intraosseous DRF placement. The aim of this study was to describe the radiographic location, prevalence and nature of complications, and long-term clinical outcomes of attempted DRF placement into the PSIS. METHODS All lumbosacral spine surgical procedures performed between August 2019 and February 2021 at a single institution were queried, and operations in which a DRF was targeted to the PSIS were included. Patient demographic characteristics, indications for surgery, surgical outcomes, and complications were extracted. Intraoperative CT scans were reviewed by 2 independent researchers to determine the accuracy of DRF placement into the PSIS and to assess for DRF malposition. RESULTS Of 497 lumbar spine operations performed between August 2019 and February 2021 by 4 surgeons, 85 utilized intraoperative navigation with a PSIS pin. Thirteen operations were excluded due to an inability to visualize the entirety of the pin on intraoperative CT. Of 72 DRFs evaluated, 77.8% had been correctly placed in the PSIS. Of the 22.2% of DRFs not placed into the PSIS, 11 entered the sacrum, 6 crossed the sacroiliac joint, and 2 were deep enough to enter the pelvis. Pain at the pin site was present in 4 patients, of whom 3 had resolution of pain at the last follow-up evaluation. There were no significant complications due to DRF placement: no sacral fractures, significant navigation errors, retroperitoneal hematomas, or neurological deficits. Over a mean ± SD follow-up period of 9 ± 5.2 months, there were no incidences of pin site infection. Interrater reliability between the reviewers was 95.8%. CONCLUSIONS This was the first study to examine radiological and clinical outcomes after DRF placement in the PSIS. In this study, a majority of pins were correctly placed within the PSIS, although 22.2% of pins were malpositioned. There were no serious complications, and a majority of those patients with persistent pin site pain had resolution at last follow-up.
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Affiliation(s)
| | | | - Clare M Wieland
- 2School of Medicine, University of Michigan, Ann Arbor, Michigan
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18
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Beisemann N, Gierse J, Mandelka E, Hassel F, Grützner PA, Franke J, Vetter SY. Comparison of three imaging and navigation systems regarding accuracy of pedicle screw placement in a sawbone model. Sci Rep 2022; 12:12344. [PMID: 35853991 PMCID: PMC9296669 DOI: 10.1038/s41598-022-16709-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/14/2022] [Indexed: 02/06/2023] Open
Abstract
3D-navigated pedicle screw placement is increasingly performed as the accuracy has been shown to be considerably higher compared to fluoroscopy-guidance. While different imaging and navigation devices can be used, there are few studies comparing these under similar conditions. Thus, the objective of this study was to compare the accuracy of two combinations most used in the literature for spinal navigation and a recently approved combination of imaging device and navigation system. With each combination of imaging system and navigation interface, 160 navigated screws were placed percutaneously in spine levels T11-S1 in ten artificial spine models. 470 screws were included in the final evaluation. Two blinded observers classified screw placement according to the Gertzbein Robbins grading system. Grades A and B were considered acceptable and Grades C-E unacceptable. Weighted kappa was used to calculate reliability between the observers. Mean accuracy was 94.9% (149/157) for iCT/Curve, 97.5% (154/158) for C-arm CBCT/Pulse and 89.0% for CBCT/StealthStation (138/155). The differences between the different combinations were not statistically significant except for the comparison of C-arm CBCT/Pulse and CBCT/StealthStation (p = 0.003). Relevant perforations of the medial pedicle wall were only seen in the CBCT group. Weighted interrater reliability was found to be 0.896 for iCT, 0.424 for C-arm CBCT and 0.709 for CBCT. Under quasi-identical conditions, higher screw accuracy was achieved with the combinations iCT/Curve and C-arm CBCT/Pulse compared with CBCT/StealthStation. However, the exact reasons for the difference in accuracy remain unclear. Weighted interrater reliability for Gertzbein Robbins grading was moderate for C-arm CBCT, substantial for CBCT and almost perfect for iCT.
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Affiliation(s)
- Nils Beisemann
- Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Berufsgenossenschaftliche Unfallklinik (BG Trauma Center) Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Jula Gierse
- Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Berufsgenossenschaftliche Unfallklinik (BG Trauma Center) Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Eric Mandelka
- Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Berufsgenossenschaftliche Unfallklinik (BG Trauma Center) Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Frank Hassel
- Department of Spine Surgery, Loretto Hospital, Mercystrasse 6, 79100, Freiburg im Breisgau, Germany
| | - Paul A Grützner
- Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Berufsgenossenschaftliche Unfallklinik (BG Trauma Center) Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Jochen Franke
- Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Berufsgenossenschaftliche Unfallklinik (BG Trauma Center) Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Sven Y Vetter
- Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Berufsgenossenschaftliche Unfallklinik (BG Trauma Center) Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany.
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19
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Garg B, Mehta N. Great Expectations with Augmented Reality in Spine Surgery: Hope or Hype?A commentary on the article 'Operator independent reliability of direct augmented reality navigated pedicle screw placement and rod bending' by Farshad et al. NORTH AMERICAN SPINE SOCIETY JOURNAL 2022; 10:100117. [PMID: 35540023 PMCID: PMC9079716 DOI: 10.1016/j.xnsj.2022.100117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Nishank Mehta
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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20
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Fiore M, Ruffilli A, Viroli G, Barile F, Manzetti M, Faldini C. Minimally invasive surgery using posterior-only Pedicle screw fixation in treatment of Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis. J Clin Neurosci 2022; 99:317-326. [PMID: 35339852 DOI: 10.1016/j.jocn.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/22/2022] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
Abstract
Minimally invasive surgery (MIS) techniques for posterior spine pedicle-screw fusion (PSF) may reduce the AIS surgery invasiveness, although they require a certain degree of patient selection based on the severity of the curve. The aim of this article is to systematically review the Literature to determine efficacy and safety of MIS-PSF in AIS correction, and to compare its outcomes with open-PSF. A systematic search of electronic databases from eligible articles was conducted. Only studies adopting MIS-PSF for AIS were included. Clinical and radiographic outcomes were extracted and summarized. Meta-analyses were performed. P-value < 0.05 was considered significant. Thirteen studies for a total of 635 patients ungergoing MIS-PSF were included in this review. Pre-operative Cobb's angle ranged from 48.3°±4.2° to 59.8°±6.6°, coronal correction from 58.1% to 79.1%, average operative time ranged from 252 to 526.8 min, average estimated blood loss from 138.8 ± 50 to 1250 mL. Sixty-seven complications were recorded (9.9%), with 19 revisions (3.8%), resulting similar to those described in Literature using open-PSF. At meta-analysis, MIS-PSF (321 patients) compared to open-PSF (429 patients) showed lower coronal correction (although no statistically significant difference was found), estimated blood loss and length of hospital stay, but higher operative time. No differences in SRS-22, complications and revision rate were found. In conclusion, open-PSF shows a trend towards higher correction in the coronal plane and requires a shorter operative time when compared to MIS-PSF. It remains the gold standard for AIS correction, although MIS-PSF seems to be a viable and promising technique for selected patients. - KEYWORDS: minimally invasive surgery, minimally invasive techniques, adolescent idiopathic scoliosis, posterior spinal fusion, pedicle-screws-only instrumentation.
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Affiliation(s)
- Michele Fiore
- Alma Mater Studiorum - University of Bologna, Bologna, Italy.
| | | | - Giovanni Viroli
- First Orthopaedic and Traumatologic Clinic - IRCCS Istituto Ortopedico Rizzoli (IOR), Bologna, Italy
| | - Francesca Barile
- First Orthopaedic and Traumatologic Clinic - IRCCS Istituto Ortopedico Rizzoli (IOR), Bologna, Italy
| | - Marco Manzetti
- First Orthopaedic and Traumatologic Clinic - IRCCS Istituto Ortopedico Rizzoli (IOR), Bologna, Italy
| | - Cesare Faldini
- Alma Mater Studiorum - University of Bologna, Bologna, Italy
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21
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A Retrospective Comparative Analysis of Perioperative Complications in Navigated versus Conventional Thoracolumbar Fusion in the Setting of Adult Spinal Deformity. World Neurosurg 2022; 162:e616-e625. [PMID: 35339712 DOI: 10.1016/j.wneu.2022.03.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Stereotactic intraoperative computer-assisted navigation has been shown to improve pedicle screw accuracy in spinal fusion surgery, but evidence of impact of navigation on clinical outcomes is lacking. The aim of this study is to compare rates of perioperative complications between navigated and nonnavigated procedures for deformity correction. METHODS An administrative database was queried for adult patients undergoing thoracolumbar fusion procedures for deformity. Nonelective cases and those involving malignancy, infection, or trauma were excluded. Individuals were divided into 2 cohorts based on the use of stereotactic intraoperative navigation and paired 1:1 for comparison based on a propensity score matching algorithm. Rates of unplanned reoperation and other perioperative complications were compared between matched groups. A multivariable Cox regression model was constructed to identify the impact of navigation on specific subgroups. RESULTS A total of 6150 patients met eligibility criteria for the study; after propensity score matching, 456 patients who underwent conventional fusion were matched to 456 patients receiving intraoperative navigation. Navigated cases took an average of 30 minutes longer than nonnavigated cases. There were no significant differences in rates of complications between cohorts. A subgroup analysis revealed that use of navigation was associated with decreased hazard for reoperation in individuals undergoing interbody fusion. CONCLUSIONS Despite increased surgical duration, the use of navigation does not seem to significantly impact rates of perioperative complications outside of procedures involving interbody fusion. Surgeons should elect to use navigation in cases expected to be of high operative complexity at their own discretion.
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22
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Shuman WH, Valliani AA, Chapman EK, Martini ML, Neifert SN, Baron RB, Schupper AJ, Steinberger JM, Caridi JM. Intraoperative Navigation in Spine Surgery: Effects On Complications and Reoperations. World Neurosurg 2022; 160:e404-e411. [PMID: 35033690 DOI: 10.1016/j.wneu.2022.01.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 01/08/2022] [Accepted: 01/08/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Intraoperative navigation during spine surgery improves pedicle screw placement accuracy. However, limited studies have correlated navigation with clinical factors including operative time and safety. This study compares complications and reoperations between surgeries with and without navigation. METHODS Posterior cervical and lumbar fusions and deformity surgeries from 2011-2018 were queried from the NSQIP database and divided by navigation use. Patients aged >89, deformity patients aged <25, and patients undergoing surgery for tumors, fractures, infections, or non-elective indications were excluded. Demographics and perioperative factors were compared with univariate analysis. Outcomes were compared with multivariable logistic regression adjusting for age, sex, BMI, ASA class, surgical region, and multiple levels. Outcomes were also compared stratifying by revision status. RESULTS Navigated surgery patients had higher ASA status (p<0.0001), more multiple-level surgeries (p<0.0001), and longer operations (p<0.0001). Adjusted analysis revealed navigated lumbar surgeries had lower odds of complications (OR=0.82, 95%CI=0.77-0.90, p<0.0001), blood transfusion (OR=0.79, 95%CI=0.72-0.87, p<0.0001), and wound debridement/drainage (OR=0.66, 95%CI=0.44-0.97, p=0.04) compared to non-navigated procedures. Navigated cervical fusions had increased odds of transfusion (OR=1.53, 95%CI=1.06-2.23, p=0.02). Navigated primary fusions had decreased odds of complications (OR=0.91, 95%CI=0.85-0.98, p=0.01); no difference was found in revisions (OR=0.89, 95%CI=0.69-1.14, p=0.34). CONCLUSIONS Navigated surgery patients experienced longer operations due to a combination of time using navigation, more multi-level procedures and larger comorbidity burden, without differences in infections. There were fewer complications and wound washouts in navigated lumbar surgeries due to a higher percentage of minimally invasive cases. Co-utilization of navigation and minimally invasive surgery may benefit properly indicated patients.
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Affiliation(s)
- William H Shuman
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, United States.
| | - Aly A Valliani
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, United States
| | - Emily K Chapman
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, United States
| | - Michael L Martini
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, United States
| | - Sean N Neifert
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, United States
| | - Rebecca B Baron
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, United States
| | - Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, United States
| | - Jeremy M Steinberger
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, United States
| | - John M Caridi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, United States
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23
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A real-time 3D electromagnetic navigation system for percutaneous pedicle screw fixation in traumatic thoraco-lumbar fractures: implications for efficiency, fluoroscopic time, and accuracy compared with those of conventional fluoroscopic guidance. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:46-55. [PMID: 34333714 DOI: 10.1007/s00586-021-06948-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/14/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Navigation is becoming more useful in percutaneous pedicle screw fixation (PPSF). The aim of this study was to compare the efficiency, fluoroscopic time, accuracy, and clinical outcomes of PPSF with a novel electromagnetic navigation (EMN) system for thoraco-lumbar (TL) fractures with those of PPSF with conventional C-arm fluoroscopic (CF) guidance. METHODS A retrospective study was conducted. A total of 162 screws were implanted in 29 patients with the assistance of the EMN system (EMN group), and 220 screws were inserted in 40 patients by using CF guidance (CF group). The duration of surgery, placement time per screw, fluoroscopic time per screw, accuracy of pedicle screw placement, and clinical outcomes were compared between the two groups. RESULTS The duration of surgery and placement time per screw in the EMN group were significantly lower than those in the CF group (P < 0.05). The fluoroscopic time per screw in the CF group was significantly longer than that in the EMN group (P < 0.05). The learning curve of PPSF in the EMN group was steeper than that in the CF group. The accuracy of pedicle screw placement in the EMN group was more precise than that in the CF group (P < 0.05). The VAS scores in the EMN group were significantly lower than those in the CF group at one-week postoperatively (P < 0.05). CONCLUSION Compared with PPSF by using conventional fluoroscopic guidance, PPSF with the aid of the EMN system can increase the efficiency and accuracy of pedicle screw placement and reduce the fluoroscopic time.
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24
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Faldini C, Viroli G, Fiore M, Barile F, Manzetti M, Di Martino A, Ruffilli A. Power-assisted pedicle screws placement: Is it as safe and as effective as manual technique? Narrative review of the literature and our technique. Musculoskelet Surg 2021; 105:117-123. [PMID: 34050490 PMCID: PMC8324584 DOI: 10.1007/s12306-021-00714-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/19/2021] [Indexed: 11/29/2022]
Abstract
Pedicle screws are the gold standard in spine surgery, allowing a solid tricolumnar fixation which is unmatched by hooks and wires. The freehand technique is the most widely adopted for pedicle screws placing. While freehand technique has been classically performed with manual tools, there has been a recent trend toward the use of power tools. The aim of this review is to summarize and expose potential risks and advantages of power pedicle screws placing. The literature showed that the use of power tools offers an acceptable safety profile, comparable to manual technique. With an adequate training, the power technique may speed up the screw placing, reduce the fluoroscopy time and the physical stress to the spine surgeon. Regarding differences in pull-out strength between power and manual techniques, the literature is still uncertain and inconsistent, both in clinical and preclinical studies. The choice between the use of power and manual freehand pedicle screws placing is still based on the surgeon's own preference.
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Affiliation(s)
- C Faldini
- Department of Biomedical and Neuromotor Science-DIBINEM, 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - G Viroli
- Department of Biomedical and Neuromotor Science-DIBINEM, 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy.
| | - M Fiore
- Department of Biomedical and Neuromotor Science-DIBINEM, 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - F Barile
- Department of Biomedical and Neuromotor Science-DIBINEM, 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - M Manzetti
- Department of Biomedical and Neuromotor Science-DIBINEM, 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - A Di Martino
- Department of Biomedical and Neuromotor Science-DIBINEM, 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - A Ruffilli
- Department of Biomedical and Neuromotor Science-DIBINEM, 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
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25
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Maruo K, Arizumi F, Kusuyama K, Yoshie N, Tomoyuki K, Tachibana T. Comparison of Clinical Outcomes After Transforaminal Interbody Fusion Using Cortical Bone Trajectory versus Percutaneous Pedicle Screw Fixation. World Neurosurg 2021; 151:e821-e827. [PMID: 33964494 DOI: 10.1016/j.wneu.2021.04.130] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The study aim was to compare clinical outcomes between patients undergoing transforaminal lumbar interbody fusion (TLIF) using percutaneous pedicle screw (PPS) and cortical bone trajectory (CBT) by a single surgeon. METHODS This was a retrospective matched-cohort study of 77 patients (mean age, 71.7 years; 56% female) who underwent TLIF using CBT or PPS. Thirty-nine consecutive patients in the CBT group and 38 patients in the PPS group were matched for age, sex, and fused levels. All CBT screws were inserted by using a three-dimensional patient-specific guide (MySpine MC, Medacta). Perioperative outcomes of operative time, estimated blood loss, numeric rating scale scores, and serum concentration of creatine kinase were compared between the 2 groups. At 1 year postoperatively, clinical outcomes and radiographic outcomes, including cage subsidence, screw loosening, and fusion rates, were compared between the 2 groups. RESULTS The numeric rating scale scores on postoperative days 3 and 7 and serum creatine kinase levels on postoperative days 1 and 3 were significantly lower in the CBT group than in the PPS group (all P < 0.005). There were no significant intergroup differences in operation time and estimated blood loss. At postoperative 1 year, there were no significant differences in cage subsidence, screw loosening, and fusion rates between the CBT group and PPS group. Clinical outcomes were equivalent between the 2 groups. CONCLUSIONS The CBT technique using three-dimensional patient-specific guides resulted in lower perioperative pain and quicker recovery after surgery, which suggests that CBT is a less invasive procedure than PPS.
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Affiliation(s)
- Keishi Maruo
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
| | - Fumihiro Arizumi
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazuki Kusuyama
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Norichika Yoshie
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kusukawa Tomoyuki
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Toshiya Tachibana
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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